Jackson A, Isherwood I
Department of Diagnostic Radiology, University of Manchester, UK.
Br J Radiol. 1994 Sep;67(801):840-7. doi: 10.1259/0007-1285-67-801-840.
The magnetic resonance appearances in 165 patients with symptoms suggestive of degenerative lumbar spine disease were reviewed. The aim of the study was to evaluate the relationship between abnormalities of nerve root distribution and degenerative disease of the lumbar spine in the absence of other known risk factors for arachnoiditis. Central clumping of nerve roots was present in 16 patients (9.7%) and was associated with spinal stenosis at one of the affected levels in all (p < 0.001). Spinal stenosis was present in 44 patients giving an incidence of abnormal nerve root distribution of 36% in this group. Nerve root clumping occurred in association with pure spinal stenosis (10 cases), stenosis secondary to disc prolapse (four cases) and degenerative spondylolisthesis (two cases). Nerve root clumping was confined to one vertebral level in nine cases and extended over two to four levels in seven. In five of the latter spinal stenosis was present at multiple levels. The appearance of nerve root clumping described here may result entirely from mechanical apposition of nerve roots but is indistinguishable from the central pattern of nerve root adhesions which occurs in adhesive lumbar arachnoiditis. No abnormalities of nerve root distribution were seen in association with any indicator of degenerative disk disease in the absence of stenosis. We have been unable to demonstrate the previously reported relationship between lumbar disk degeneration and arachnoiditis and discuss this with a critical review of the literature. Abnormal central clumping of nerve roots as described in arachnoiditis may occur in association with spinal stenosis in the absence of other risk factors although the cause for this appearance remains unexplained. Arachnoiditis-like changes extending over more than one vertebral level are rare (7%) except in the presence of spinal stenosis at multiple levels (29%). Awareness of this appearance may avoid a possibly incorrect diagnosis of arachnoiditis in the presence of a treatable stenosis.
回顾了165例有退行性腰椎疾病症状患者的磁共振成像表现。本研究的目的是在不存在其他已知蛛网膜炎危险因素的情况下，评估神经根分布异常与腰椎退行性疾病之间的关系。16例患者（9.7%）出现神经根中央聚集，且均与受累节段之一的椎管狭窄相关（p<0.001）。44例患者存在椎管狭窄，该组神经根分布异常的发生率为36%。神经根聚集与单纯椎管狭窄（10例）、椎间盘突出继发狭窄（4例）和退行性椎体滑脱（2例）相关。9例患者神经根聚集局限于一个椎体节段，7例患者延伸至两到四个节段。在后一组中的5例患者存在多个节段的椎管狭窄。此处描述的神经根聚集表现可能完全由神经根的机械性并置导致，但与粘连性腰椎蛛网膜炎中出现的神经根粘连的中央模式无法区分。在不存在狭窄的情况下，未发现与退行性椎间盘疾病的任何指标相关的神经根分布异常。我们未能证实先前报道的腰椎间盘退变与蛛网膜炎之间的关系，并结合文献的批判性综述进行了讨论。在不存在其他危险因素的情况下，如本文所述的神经根中央异常聚集可能与椎管狭窄相关，尽管这种表现的原因尚不清楚。除了存在多个节段的椎管狭窄（29%）外，蛛网膜炎样改变延伸超过一个椎体节段的情况很少见（7%）。认识到这种表现可以避免在存在可治疗的狭窄时可能错误地诊断为蛛网膜炎。
